Individual
SAMANTHA INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6828 LACKMAN RD, SHAWNEE, KS 66217-9595
(913) 608-7435
Mailing address
6828 LACKMAN RD, SHAWNEE, KS 66217-9595
(913) 608-7435
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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